Other antineoplastics: Nursing pharmacology

Antineoplastic agents are medications used to treat cancer. Except for the usual antineoplastics, there are other medications that can be also used to treat various forms of cancer, particularly acute lymphoblastic leukemia or ALL, ovarian cancer, and cutaneous T-cell lymphoma.

Other antineoplastics that are commonly used include asparaginase, and pegaspargase, which are given intramuscularly or intravenously to treat acute lymphoblastic leukemia, as well as altretamine, which is taken orally to treat ovarian cancer.

Then there’s azacitidine, a medication that can be administered orally, intravenously or subcutaneously to treat myelodysplastic syndrome or acute myeloid leukemia; hydroxyurea, which is administered orally in clients with chronic myeloid leukemia or head and neck cancer; and irinotecan, which is administered intravenously to clients with metastatic colorectal cancer.

Once administered, what asparaginase and Pegaspargase do is break down asparagine, which is a non-essential amino acid, into aspartic acid and ammonia.

Cancer cells can’t synthesize asparagine themselves, so this impairs their protein synthesis, ultimately stopping cellular processes and causing apoptosis.

On the other hand, the way altretamine works is not perfectly clear, but it could damage cancer cells by crosslinking of DNA, which means the agent links two DNA bases together, forming cross-bridges.

Cross-linking prevents DNA from being separated for essential cell processes, like replication or transcription, eventually resulting in cancer cell death and stopping the multiplication of cancer cells.

Next, azacitidine causes damage to double stranded DNA during cell replication, while hydroxyurea and irinotecan inhibit enzymes involved in DNA synthesis, ultimately stopping cancer cell division.

Irinotecan in particular belongs to a group of medications called topoisomerase I inhibitors, so it inhibits this enzyme to eventually cause double stranded DNA breaks and halt cell replication.

Unfortunately, these medications can also damage healthy cells and cause side effects. All of them, with the exception of asparaginase and Pegaspargase can cause dermatological reactions, like skin rashes, eczema, pruritus and alopecia; and bone marrow toxicity, which is a boxed warning for altretamine, hydroxyurea and irinotecan.

Bone marrow suppression can lead to anemia; leukopenia, increasing the risk of infections; and thrombocytopenia, increasing the risk of bleeding.

Gastrointestinal toxicity, which can manifest as nausea, vomiting or diarrhea, is also a common side effect, and irinotecan actually has a boxed warning for causing severe diarrhea.

Other boxed warnings include neurotoxicity for altretamine, and the risk of developing a secondary malignancy after prolonged use for hydroxyurea.

And now for specifics. Azacitidine can cause injection site reactions, as well as fever, fatigue, respiratory infections, nephrotoxicity and tumor lysis syndrome.

Asparaginase and Pegaspargase can both cause serious hypersensitivity reactions, and asparaginase can additionally cause fever, hepatotoxicity, nephrotoxicity, and hyperglycemia.

Altretamine can also cause hepato- and nephrotoxicity, while hydroxyurea also comes with a risk of fever, headache and stomatitis.

Finally, treatment with irinotecan can lead to cholinergic syndrome, which encompasses a lot of parasympathetic reactions, including diaphoresis; or excessive sweating; flushing; increased peristalsis; miosis; sialorrhea, or excessive salivation; and rhinitis.

Other side effects for irinotecan include fever, neurotoxicity, hepatotoxicity, and pulmonary toxicity. Now, these other antineoplastics are generally contraindicated during breastfeeding, and they should also be used with caution during pregnancy.

Asparaginase andPegaspargase should also be avoided in clients with a history of pancreatitis, thrombosis or hemorrhagic events with previous asparaginase treatment.

Altretamine should be used with caution alongside monoamine oxidase inhibitors treatment, since using the two together can increase the risk of hypotension.

Hydroxyurea, on the other hand, should be used with caution in the elderly population, people with renal problems, or those who have received radiation therapy in the past; and when used together with some medications used to manage the HIV infection, that can increase the risk of hepatotoxicity, peripheral neuropathy and pancreatitis.

Finally, irinotecan should be given with caution in the elderly population, people with renal disease, or people with hepatic impairment.

Okay, when caring for a client with acute lymphoblastic leukemia who has been prescribed an antineoplastic agent like IV asparaginase, begin your assessment by asking about current symptoms, including fatigue, dizziness, easily bruising or bleeding, bone pain, unexplained fevers, or abdominal fullness.

Then, obtain their weight and vital signs, and review their most recent laboratory test results, including CBC, coagulation studies, hepatic function, blood glucose, amylase and lipase.

Lastly, review diagnostic tests, including peripheral blood smear and bone marrow examination results. All right, moving on to client education.

Explain how the medication will help to treat their cancer as part of their chemotherapy regimen, and that it will be administered intravenously daily for 28 days.

Let your client know that they may experience nausea or vomiting, and advise them to eat small, frequent meals, as well as to increase their fluid intake during treatment.

Prompt your client to notify their healthcare provider if they experience symptoms of pancreatitis, which can manifest as nausea, abdominal pain that occurs after eating, or pain in the upper abdomen that radiates to the back; as well as symptoms of hepatotoxicity, which include fatigue, anorexia, abdominal pain, dark urine, or yellowing of the eyes or skin; and symptoms of hyperglycemia, which can cause increased hunger and thirst, along with increased urination and frequency.

Lastly, let your client know that they will need to follow up regularly for laboratory test monitoring. Okay, when preparing to administer asparaginase intravenously, be sure that emergency equipment and medications are readily available, and that your client has a patent large-bore IV or central line in place.

Also, ensure they are adequately hydrated with the ordered IV fluids; and premedicate your client with the ordered antiemetic 30 to 60 minutes before you begin the infusion.

Then, confirm the correct dose by calculating units per kilogram of body weight, and input the correct mL/hr to be administered by infusion pump.

Also, be sure to wear gloves and other protective clothing when handling the medication. While your client is receiving the medication, monitor vital signs and for indications of a hypersensitivity reaction, including shortness of breath, difficulty swallowing or breathing, or an unusual rash.

If a reaction does occur, be prepared to stop the infusion and administer emergency medications as ordered.Finally, during treatment with an antineoplastic agent like asparaginase, be sure to monitor your client’s laboratory test results, as well as for the development of side effects.

Lastly, be sure to evaluate for the desired therapeutic effect of a decrease in symptoms of their acute lymphoblastic leukemia.

All right, as a quick recap… Antineoplastic agents are medications used to treat cancers such as acute lymphoblastic leukemia, ovarian cancer, cutaneous T-cell lymphoma, acute and chronic myeloid leukemia, and head and neck cancer.

Commonly used medications in this category include asparaginase and pegaspargase, which impair protein synthesis of cancer cells; altretamine, which works by cross-linking DNA and preventing DNA from being separated during essential cell processes; azacitidine, which works by damaging double stranded DNA during cell replication; and hydroxyurea and irinotecan, which inhibit enzymes involved in DNA synthesis.

Unfortunately, these medications can also damage healthy cells, causing side effects like dermatological reactions, bone marrow suppression, and gastrointestinal disturbances.

When caring for a client receiving an antineoplastic medication, nursing considerations include performing a baseline assessment, monitoring for side effects, and evaluating the desired therapeutic effect.

Client education is focused on what to expect during treatment, as well as learning to recognize side effects and when to notify the healthcare provider.

cross-linking DNA in preventing DNA from being separated during essential cell processes as a cytidine which works by damaging double-stranded DNA during cell replication, and hydroxyurea and irinotecan, which inhibit enzymes involved in DNA synthesis.

Unfortunately, these medications can also damage healthy cells causing side effects, like Dermatological reactions bone marrow suppression and gastrointestinal disturbances when caring for a client receiving an antineoplastic medication.

Nursing considerations include performing a baseline assessment monitoring for side effects and evaluating the desired. Therapeutic effect client education is focused on what to expect during treatment as well as learning to recognize side effects.

And when to notify the healthcare provider,